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Medical

The medical plan design offered to employees is a $15 HMO Plan or High Deductible PPO Plan. You may elect coverage provided through one of the two medical carriers, UnitedHealthcare HMO or PPO, Kaiser Permanente HMO.

• About the HMO Plans
• About the PPO Plan
• Benefit Summaries
• Medical Costs
• Share the Savings Program

About the HMO Plans

Under a Health Management Organization (HMO) plan, you typically need to use doctors, hospitals, facilities, and other plan providers affiliated with the HMO. Your out-of-pocket costs are typically limited to copays for the services you receive; the plan pays the balance. Services are not subject to a deductible.

If you enroll in the UnitedHealthcare HMO plan, you need to designate a Primary Care Physician (PCP) for yourself and each of your covered dependents. (Our medical plans allow you to choose a different PCP for each person, if desired.) Provider directories are available through each plan’s Web site.

If you do not choose a PCP, one will be designated for you by the plan; you may change your PCP at any time.

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About the PPO Plan

"PPO" stands for "Preferred Provider Organization." Under the PPO plan, you may visit any provider and you do not need a referral to do so. However, when you use a UnitedHealthcare PPO network doctor, hospital or laboratory, you pay less out-of-pocket because the provider charges are capped, and the plan covers a higher percentage of covered services. When you use providers outside the UnitedHealthcare PPO network, the plan pays a percentage of their fees and charges up to the plan’s “Reasonable and Customary” (R&C) payment limits. Provider charges in excess of R&C limits are your responsibility.

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Plan Highlights Sheets

For details on each medical plan’s design refer to the highlights sheets below:

• UHC HMO (PDF - 116kb) *
• UHC PPO (PDF - 224kb) *
• Kaiser HMO (PDF - 89kb) *

Contact the plan carriers directly, if you have questions regarding the benefits covered.

In reviewing this information, please be reminded that these documents provide a brief summary of the plans only.

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Summary of Benefits and Coverage

In addition to the Plan Highlight summaries located above, also available are the Summary of Benefits and Coverage (SBC) as required under Health Care Reform.

• UHC HMO SBC (PDF - 147kb) *
• UHC PPO SBC (PDF - 112kb) *
• Kaiser HMO SBC (PDF - 484kb) *

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Medical Costs

The County has 2 contribution categories:

1. The County pays 90% of the monthly medical premium for all HMO plans and
   90% of the lowest cost HMO plan premium for the PPO Plan, or
2. The County pays 100% of the lowest cost HMO plan premium for all medical plans.

Employees must work at least 50% of their standard hours per pay period and, if so, for their eligible dependents.

Employees need to refer to their MOU's to determine their contribution category.

• Employee (Self)
• Employee + one (Self+1)
• Employee + two or more (Family)

Refer to the following rate sheets for the costs that are effective as of:

• February 1, 2013 (PDF - 87kb) *
• February 1, 2012 (PDF - 17kb) *
• February 1, 2011 (PDF - 195kb) *
• February 1, 2010 (PDF - 142kb) *
• February 1, 2009 (PDF - 146kb) *
• February 1, 2008 (PDF - 33kb) *
• February 1, 2007 (PDF - 16kb) *
• February 1, 2006 (PDF - 13kb) *

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Share the Savings Program

You have the option to waive County-sponsored medical coverage for yourself and/or your eligible dependents if you have coverage under another source. If you choose to waive medical, you may be eligible to receive a monthly stipend of up to $100, through the Share the Savings program.

The chart below indicates the Share the Savings stipend amounts available to employees working full-time.

Share the Savings Stipend

If You:	You Will Receive a Stipend of up to:
Decline all medical plan coverage	$100
Reduce your coverage from "Family" to "Self"	$75
Reduce your coverage from "Family" to "Self + 1"	$50
Reduce your coverage from "Self + 1" to "Self"	$50

The Share the Savings stipend is prorated if the hours you work in a pay period are less than 100% of your job classification’s standard job hours. Employees working less than 50% of standard hours in a pay period are not eligible.

To decline medical coverage and enroll in the Share the Savings Program, you must demonstrate you have coverage under another medical plan, for example, through your spouse’s employer. Acceptable proof of coverage includes:

• Letter from the administrator of the alternate medical plan (i.e., spouses employer, an agency or organization)
• Letter from the medical carrier that is providing the alternate medical coverage
• Online print-out from the alternate medical carrier's website

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* Portable Document Format (PDF) file requires the free Adobe Reader.